Kigali and Kabuga, Rwanda

It is impossible for me to be frustrated with a Rwandan for long. The softness of their eyes, the calmness of their demeanors and dispositions, the gentleness of their voices, disarms me utterly.

I had trouble sleeping this morning, in spite of having organized my time to allow for a ‘long lie in,’ as Dario calls it. When someone knocked on the door while I fast asleep, I pretended it didn’t happen. The knock repeated, and I stumbled to the door to find Dan, a young yet wise looking presence, holding my breakfast room service order card. To counter his move, I showed him the do not disturb card hanging on my doorknob.

He proceeded to tell me what seemed like a very long story about how my order was indicated for after the breakfast that comes with the room charge closes, and how there would be a charge for my meal if I wanted my omelet that late.

I couldn’t keep up. I just heard his lilting, kind voice. I interrupted. “Dan, please stop talking!”, I squeaked, as tried to rouse myself. I really wanted to talk about the DND on the door. I was stuck on that. He told me Mr. James in management had deemed the possibility of charging me for my meal grave enough that it merited over riding my DND and knocking on my door. I sighed. Dan smiled how I think God smiles, with infinite patience, loving detachment, like he had all the time in the world for me to straighten myself out.

When he later brought my meal in, I studied his face, his posture. Beautiful. The grace and dignity that quietly emanated from him moved me.

I began remembering my staggering visit to the genocide memorial here, and decided I couldn’t go today. It’s too much. I will visit it again some time, but I have visited the Jewish Quarter in Prague three times since May, and am going to the Terezin concentration camp soon. I can only handle so much in the way of massacres. (Feeling dizzy as I write this….)

I can’t even visit the genocide museum. How can Dan and his family live through it, and then tolerate with such elegance sleepy hotel guests who feel perturbed when their breakfast is not delivered at their specified time?


Dushishoze, roughly translated, means “stay vigilant.” It is an invitation. It is an admonition. Through a safe place with plenty of interior and exterior room to play, as well as provisions such as a basketball hoop, volleyball net, and a stereo, Dushishoze attracts thousands of vulnerable youth. Kids are provided a full basket of holistic services that range from age and context appropriate reproductive health education, to voluntary counseling and testing for HIV, to literacy, to financial literacy, to vocational training and career counseling. Additionally, Dushishoze is a place where high risk groups, such as girls and women in economically forced prostitution (EFP) and men who have sex with men (MSM) are reached with life saving behavior change communication. Many of them become peer educators, thus earning a small income that helps reduce the number of sex partners they must have for their survival, as well as empowering them to reach other prostituted people with critical public health messages and behavior change. (Dushishoze is funded by the Center for Disease Control and the Global Fund to Fight AIDS, Tuberculosis, and Malaria.)

I am dead tired and strangely in no mood to capture the full day, which typically is mandatory, almost a compulsion. Instead, for now I just want to share facts. Maybe latter I will put narrative meat on the bones.

Little things say a lot about Rwanda. Every kid with whom I spent time, whom I saw (about 300+) was clean. Even those wearing white, their white garment was unsullied. I did not see a shoeless kid all day, except for two very small toddlers at sunset (they were also the only dirty ones). Oh, how that will change tomorrow, when I cross into DRC.

It was a joy to see so many kids streaming about, playing running, engaging in their different games. There was music playing in parts of the center, up beat education sessions (condom demonstration was one), and obvious friendships and alliances being shared. That is one of the things I like about Dushishoze. It is a safe place, kids can drop it. It’s not obligatory to partake in the services. There is no pressure. Life is hard enough for these kids….

But some of the young people were very focused, and eager to share their life stories with me, and the ways in PSI is helping them. In particular, women in EFP and MSM had gathered.

The young women with whom I sat on shaded grass were direct and plainspoken about their plight. Every single one had “taken the decision” to engage in “commercial sex” (NGO and supranational body speak for economically forced or coerced sexual exploitation). They described their choiceless-choice matter of factly:

“I am an orphan. At 14, I decided this is what I had to do, in order to survive.”

“I was in my second year bac (baccalaureate), but I had no money, no one ot support me, and no job, to continue to pay for my studies. I decided to do this to earn money, so I can eventually continue my schooling. I heard about doing this from a friend.”

“A man was always following me, harassing me, begging me to have sex with him. He offered me money and things I needed to survive. Finally, I just said yes.”

I spoke in total with 17 young women. As they had been identified by PSI as capable of becoming peer educators entrusted with the urgent task of sharing HIV prevention and other health messages with others caught in sexual exploitation, all were literate. Shockingly, their average schooling was almost year 6 of secondary. That is so very high, compared to most women in EFP. It speaks to the critical need for economic and employment empowerment of girls and women….formalization of work, too….

They need to have paid sex with about 9 men per week in order to eek out a subsistence life. Each is supporting other vulnerable youth, mostly little brothers and sisters. They tend to “work” on weekends, and the location is general public places and road sides, although forced prostitution does happen in night clubs and hotels.

They earn about $8 US per man. They are often asked to have sex without a condom, even though knowledge that proper use of a condom helps reduce the risk of spreading HIV. Typically, a man offers double for sex without a condom. (10,000 R Fr, versus 5,000 R Fr).

(HIV prevalence amongst women in economically forced prostitution is 50%. The national sero prevalence is 2-3%.)

“What do you say?” I asked. How do you safely insist?

“If I am particularly desperate,” one replied, I take the 10,000 R Fr, but I know it is dangerous and I prefer not to. But sometimes, I do. I can’t help it. Look at me. I am so skinny. I need to eat.”

Another said, “I can tolerate being poor and hungry; I’d rather earn less, and live a longer life.”

And one, one with anger, said something that I want never to be taken out of context. In an expression of her disempowerment and powerlessness over her circumstances, frustration at being dependent upon men who exploit her in order for her subsistence survival, she said rhetorically, “If I am HIV negative, I take the lower price and use a condom. If I am HIV positive, I take the larger sum, and do not use a condom.” What other power does the child have, than to imagine those who hurt her, being hurt? May her pain and anger be transformed into social justice action on behalf of herself and her peers.

Our talk was very long. But I will leave you not with more harrowing details of their predicament and despair, but rather, their dreams.

Alice wants to finish university, and own a tourism business, to work with those who visit Rwanda, providing services.

Christine wants to resume her high school education, and go on to university, and become either a professor or doctor.

Giselle wants to be a “big businesswoman.”

And Beaute, yes, Beaute, one of the orphans, the one who would boldly wink at me, then in a fit of bashfulness turn her head aside, the one who when we were taking a picture was on her knees in front of me, and reached up to simply touch my skirt….then laughed off her shyness and grabbed my leg, said, “I want to finish school, and start a family. Then I want to help other girls who have been in my situation. I want to become a great mentor. I want to be like you.”

The MSM: The story of discrimination is really the same worldwide. One thing that stood out to me was that in their concerns, they expressed their lack of a safe space, their own area where they can go when they are rejected by their families and ostracized by society. I felt sad about that. A young man named Chris said recently, even women trapped in position were afraid of them, fearing MSM would take their paying clients away from them. They are truly on their own (I saw this in action on the streets of Antananarivo, Madagascar.)

They have benefited greatly from PSI’s interventions, have learnt life saving lessons about their sexual behavior and how to educate their peers. But there is so much more they need. I described to them my own painful education around the fact that PSI is a public health agency; that is our core competency. As they gain voice, self-confidence, and skills, they can organize themselves to address their other challenges, and align with other organizations, and even found their own. PSI can help them with health. I maintain PSI is a health and human rights agency. We offer the A’s (accessibility, affordability, and acceptability) and the Q (quality) that human decency and dignity demands. But we are not a human rights agency, per se, and if you don’t know the difference, don’t worry about. There is an entire class at the Harvard School of Public Health about it. I do trust that the health empowerment (which is the essential building block of development) they can gain via PSI is a valuable stepping-stone toward broadly advocating their best interests and rights here in Rwanda.


The day was a good one. Today PSI hosted the Minister of Health as we launched a new pilot program, 12+, funded by the Nike Foundation (note to self, send Marie Eitel, chair, an e mail before bed). 112+ fills an important identified gap in social services: pre adolescents were grossly underserved. Thus 12+ brings 12 year old girls together one Saturday a month for intensive Thus 12+ mentoring from 15-22 year old girls, including health, life skills, etc. The goals are to nurture girls’ self-efficacy, self esteem, build healthy relationships and interdependence, and create future leaders. 600 12 year olds are participating in the pilot phase!

Other highlights include:

  • Behavior Change Communication Campaigns: “Don’t Wait” campaign, teaching parents how, and encouraging them, to talk to their children about reproductive health, sexual behavior, and how to avoid exploitation. Other campaigns include “Je ne suis pas pour vendre,” I am not for sale, raising awareness about Sugar Daddies/Sugar Mamas (cross generational and transactional sex).
  • Safe Drinking Water: Next week, PSI begins free distribution of 500,000 bottles of Sur Eau to the “nooks and crannies” of most rural Rwanda. Sur Eau is our point of use water purification solution (I am too tired to look up stats about access to improved water source; I know prevalence of piped water is a scant ~2% nation wide.
  • Malaria: 82% of all households posses a long lasting insecticide treated net; 72% of all children under 5 are sleeping under one. PSI has been pivotal in significantly reducing burden of Malaria in this country. Huge!
  • Family planning: Contraceptive coverage leapt from 27% in 2008 to 45%! PSI is a leader in offering women modern family planning choices. And choices are exactly what they are. Choice is emphasized. Generally, older women and women who already have children prefer longer lasting reversible methods; younger women prefer the shorter acting options. (If you believe, as I do, that modern family planning is absolutely core to poverty reduction and integral to development solutions, you probably like looking at data. Check out the Demographic Household Survey.)
  • Decentralization and Localization: PSI registering a partner local NGO, and opening 5 regional offices. All staff is local. This is increasing local capacity for technical expertise and service delivery, creating community self-efficacy and generating employment as well as stimulating local economies. Coordination, quality assurance and technical assistance will continue to come from PSI to support the transfer and implementation of all programs to the locally registered NGO, Association of Family Health (this is the future!!!!).

I love storing away all these facts, all this good news, in my mind. I review it, piece by piece as I sleep. But what will get me tonight? What will wake me at dawn, provoking tears, or anger? The faces, probably, the rows and rows of children and adolescents listening to intently to the lessons being taught. It was as if they knew their lives depend on it.


These diaries are just that: diaries. They are written quickly at the end of long days, and are often raw, unfinished thoughts as I process the day’s colorful, painful, didactic, enraging, inspiring, moving events.

I proofread, but barely. Facts are usually accurate although I do my final fact checking later, as I prepare my written work for my personal archives, or for publication. Thus, if you catch an inconsistency, or errant number, please don’t use that as an excuse to dismiss the exercise wholesale. I promise I, and my mentors, will catch and vet it later.

I choose to share them in order to carry to you in something close to real time the visceral reality of experiences embedded in poverty, vulnerability, resilience, and hope.

If they are abused in any way, such as taken out of context or reprinted beyond fair use, I will no longer post them.

I hope you will read them for what really matters, the human stories they bring to you, and details about the creative, inexpensive grassroots solutions that empower and save lives.